HomeMy WebLinkAboutApplicationtar$aJd C*øngr
6 E6¡ffilynity Development Department
- -" rog 8th street, sulte 4oL
0tI i [l 2¡ß"n*ood springs, co 81601
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E com ulti-Fa fl Demolition
E Manufactured Home (Sinele or Multi-Level)¡Reroof! Residential (SF, DuplexorTownhome)
Property Owner:
Mailing Address:
Email Address:
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Phone: tnoll'l 2'qç ay
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l" Za*tft6on",(hÒ ß/ø -3 2.4ç(Contractor:
Mailing Address:
Email Address:
Phone: ( )Architect:
Mailing Address:
Email Address:
Email Address:
Phone:Engineer:
Mailing Address
Phone: (_)
Describe Work:
Height:
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,n(^5o
8-
Block
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ð (-Ð
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Lot
Manufactured Home lnstaller:
Sq. Ft. of Building:'7-'4û0
Size (Sq. Ft. or Acres):
Job Address:
' #of
Owne/s Valuation of Work:
Sub.
Mailing Address
Email Address:
Floors: '%
Assesso/s Parcel Number:
Class of Work:New [_] Alteration L l Rdd¡t¡on I nepair I I tvtove/nelocation
[JDetachedGarage:!Rttached lJ&^,-?)
PROJECT DÊ'TAI LS CONTI NUED
Septic:OWTS
Type of Heat:Natural Gas Propane
Driveway Permit hxempt
NOMSE
Authoritv. This application for a Building Permit must be
or an authorized agent. lf the signature below is not that
Community
Electric r Other
Permit #:
signed by the Owner of the property, described above,
of the Owner, a separate letter of authority, signed by
the Owner, must be providcd whh thls Âpplicatiotr.
Legal Access. A Builcling permit cannot be issued without proof of legal arrd adequate access to the property for
purposes of inspections by the Building Division.
required: (1) State Electrical Permit, (2) County OWTS Permit,Other its.Multiple separate permits maY be
(3) another permit required for use on the property identified abovc, e.g. State or County Highway/ Road Access
or a State Wastewater Discharge Permit.
Void permit. A Building Permit becomes null and void if the work authorized is not commenced within 180 days
of the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
CERT}FICATION
I hereby certify that I have read this Application and
understand that the Building Division accepts the Ap
that the information contained above is true and correct. I
plication, along with the plans and specifications and other
Date
data submitted by me or on my behalf (submittals), based upon my certification as to accuracy. Assuming
completeness of the submittals and approval of this Application, a Building Permit will be issued granting
permission to me, as owner, to construct the structure(s) and facilities detailed on the submittals reviewed by
the Building Division. ln consideration of the issuance of the Building Permit, I agree that I and my agents will
comply with provisions of any federal, state or local law regulating the work and the Garfield County Building
Code, OWTS regulations and applicable land use regulations (County Regulation(s)). I acknowledge that the
Building permit may be suspended or revoked, upon notice from the County, if the location, construction or use
of thestructure(s) and facility(ies), described above, are not in compliancewith County Regulation(s) orany
other applicable law.
I hereby grant permission to the Building DÌvision to enter the property, described above, to inspect the work' I
further acknowledge that the issuance of the Building Permit does not prevent the Building official from: (1)
requiring the correction of errors in the submittals, if any, discovered after issuance; or (2) stopping
construction or use of the structure(s) or facility(ies) if such is in violation of County Regulation(s) or any other
applicable law. Review of this Application, including submittals, and inspections of the work by the Building
Division do not constitute an acceptance of responsibility or liability by the County of errors, omissions or
discrepancies. As the owner, I acknowledge that responsibility for compliance with federal, state and local laws
and County Regulations rest with me and my authorized agents, including without limitation my architect
er, engineer or builder
I hereby acknowledge that I have read and understand the Notice and Certification above, as well as, have
provided the required information which is correct and accurate to the best of my knowledge.
''l.,.-'
Property Owner Print and Sign
Special Conditions:
Misc Feese Fee:ManuFee:00Fee:Ad¡usted Valuation:
OWTSBP NolBaDue:
.cÕ
Paidr æTotales
ZoConstoccSetba
BUILDING / PLANNING DIVISION :
Signed Approval Date